Did you know that:
- 10% of all contact sport athletes sustain concussions each year.
- The CDC estimates that 1.6-3.8 million concussions occur each year in the US; with many going unreported.
- Athletes who sustain a concussion are 4-6 times more likely to sustain a second concussion.
- The leading cause of sports concussion is football in youth males and soccer in youth females.
- When properly treated, most people with concussions recover completely.
Concussions are caused by a bump, blow, or jolt to the head or body; which subsequently causes the brain to move back and forth, side to side, or twist within the skull. While the brain is cushioned by cerebrospinal fluid, even a mild injury can cause serious damage. Concussions are considered a form of Traumatic Brain Injury; however, they are easy to miss because the injured person is unlikely to seek immediate medical treatment and diagnostic imaging such as MRI, CT Scan, or X-rays are usually normal. Furthermore, symptoms may take time to develop.
Physical symptoms include headaches, drowsiness, dizziness, difficulty with balance, nausea, vomiting, fatigue, double or blurred vision, loss of consciousness, change in sleep patterns, and sensitivity to light and sound.
Cognitive and emotional symptoms include memory difficulty, confusion, difficulty with concentration, slowed processing, “fogginess”, difficulty speaking and communicating, irritability, anxiety, depression, aggression, mood swings, poor tolerance of stress, and restlessness.
People of any age can sustain a concussion. Car accidents, participation in sports, falls, and being struck by an object are all major causes of concussion. If not recognized early, concussions can lead to permanent brain damage, disability, and even death. Concussions in children and young adults are particularly dangerous because the brain is still immature and more vulnerable to repeat concussion.
Early recognition of a possible concussion is crucial to the management, treatment, and recovery from concussion. Concussions frequently occur during practices for recreational and travel team sports; where the coach may be the only adult in attendance. It is virtually impossible for the coach to watch the full field of players for injury when they only have one set of eyes. Parents, coaches, and athletes are encouraged to monitor practices and games for injuries. When an injury is suspected, the athlete should be immediately removed from play and examined by a medical professional. In most cases, this will require a trip to the pediatrician, primary care physician or urgent care as it is unlikely that there will be a physician, nurse, or athletic trainer onsite to perform the initial examination. If consciousness is lost or the symptoms are severe, the person should immediately go to the emergency room. In any event, the initial examination will include a neuropsychological assessment, physical assessment, and balance assessment
Early treatment for concussion is vital for long term recovery. The problem with concussion recovery is that each injury is unique and requires a medically-based recovery program individually tailored to the person’s initial and ongoing symptoms, and responses to treatment. While timeframes will vary greatly, recovery will include a progression through the following steps:
- Period of Complete Rest – No phones, computers, TV, music, school, sports, exercise, work, bright lights, noisy environments until all symptoms have resolved. Sleep, proper hydration, and healthy nutritional intake are necessary for recovery. This may take 3-7 days or more.
- Graduated Return to Activity– Slow resumption of basic physical and mental activities. If any symptoms resume, activities must again be reduced until symptom-free.
- Return to Play- Healthcare professionals such as Certified Athletic Trainers and Physical Therapists are trained to implement a formal Return to Play protocol which is sports specific and prepares the athlete to return to competition. During this time period, symptoms are monitored for regression and treatment is adjusted.
If symptoms persist, additional treatment from skilled medical professionals will likely be required. This may include interventions by specialties such as Neuroopthamology, Physiatry, Neuropsychology, Physical Therapy, Occupational Therapy, Vestibular Rehabilitation, Vision Therapy, Sub Maximal Endurance Training, and so forth.
When treated properly, recovery from concussions can be complete, with full return to previous activity level likely. It is imperative that parents, athletes, coaches, and medical professionals work together to create a climate of early identification of symptoms, a thorough evaluation of individual needs by appropriate medical professionals, and planned implementation of a recovery protocol. Failure to do so will likely result in long term consequences that include repeat concussions, permanent brain damage, and inability to all activities of life to its fullest.
Dr. Lori Schneider is a Physical Therapist and Regional Director for Access Physical Therapy and Wellness.